Action Points

Gout was associated with a high level of cardiovascular, metabolic, and renal comorbidities and led to substantial direct and indirect costs.

Note that the comorbid burden was more prevalent among gout sufferers with higher serum uric acid levels and more frequent attacks.

Gout was associated with a high level of cardiovascular, metabolic, and renal comorbidities, and led to substantial direct and indirect costs, according to a Canadian systematic review.

Out of 15 studies that met eligibility criteria, three controlled studies reported all-cause total direct costs based on specific populations at $4,733, $16,925, and $18,362 per-capita among employed (mean age 46), elderly (mean age 71), and treatment-refractory (mean age 50) gout populations, respectively, reported Sharan K. Rai, BSc, of the Arthritis Research Centre of Canada in Vancouver, and colleagues.

In addition, the comorbid burden was more prevalent among gout sufferers with higher serum uric acid (SUA) levels and more frequent attacks. Those with SUAs of >9mg/dL or annual attacks had a higher prevalence of hypertension, renal impairment, chronic kidney disease, dyslipidemia, and ischemic heart disease, the authors stated.

It may once have been the disease of kings, but gout now affects an increasing number of "commoners," specifically 3.9% of the U.S. population (8.3 million) over the past few decades. A 2103 literature review estimated the economic burden of gout at more than $6 billion annually for prevalent cases.

Rai's group synthesized data from eligible gout studies dating from 1946 to 2014. Twelve were from the U.S., while one originated in each of Canada, Taiwan, and Spain. The researchers extracted relevant economic parameters and inflated-adjusted reported costs to 2013 U.S. dollars.

The study looked at both overall direct costs of care and direct costs by gout severity or SUA level, as well as indirect costs incurred by work impairment and lost productivity. Not many of the studies in question compared gout patients with gout-free controls, and the researchers called for the inclusion of a gout-free comparison group in future research.

Two uncontrolled studies in the sample estimated total all-cause direct costs in unselected gout populations at $11,080 and $13,171 respectively. Gout-related costs ranged from $172 to $6,179, depending on population characteristics.

Unsurprisingly, several studies reported higher costs related to concurrent illnesses in gout patients. "These data suggest that the care of comorbid conditions may be an important contributor to the overall economic burden of gout," Rai's group wrote.

Four studies addressed indirect, disability-related costs. One controlled study found indirect workers' compensation costs of $1,789 versus $961 for gout versus non-gout patients. Another analysis estimated indirect costs to be as high as $4,341 per capita for treatment-refractory patients having eight flares per year, each accounting for a loss of 3 workdays.

The study had some limitations. The identification and selection of relevant citations may have been skewed by publication bias, and the heterogeneity of cost data across differing studies precluded a quantitative meta-analysis.

The authors called for future research to produce population-based cost estimates of gout using appropriate comparator groups and for a comprehensive assessment of direct and indirect costs.

Rai and most co-authors disclosed no relevant relationships with industry. One co-authors disclosed relevant relationships with AstraZeneca and Takeda Pharmaceuticals.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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